Shadia Ahmed, M.D.
Individual provider Active NPI Family Medicine Physician · Tustin, CA
NPI 1457566036 · NPPES record last updated Dec 3, 2021
Key facts
- NPI
- 1457566036
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- A93769 (CA)
- Practice address
- 16634 Sonora St
Tustin, CA 92782-1938 - Phone
- (949) 251-9290
- NPI assigned
- May 14, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern California Permanente Medical Group
Practice addresses (Care Compare)
411 N Lakeview Ave
Anaheim, CA 92807-3028
Phone (714) 279-4000
5475 E la Palma Ave
Anaheim, CA 92807-2075
Phone (714) 279-6088
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081128000073 | CA | Practitioner - Family Practice | 2668532219 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A93769 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Southern California Permanente Medical Group | Current |
Accepting new patients |
Locations
5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088
441 N Lakeview Ave
Anaheim, CA 92807
Phone (714) 279-4000
393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A93769 | CA | Yes |
Addresses
Primary practice location
16634 Sonora St
Tustin, CA 92782-1938
Mailing address
16634 Sonora St
Tustin, CA 92782-1938
Phone (949) 251-9290
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in Tustin, CA
- Dustin Livingston Agnelli
- Daisy Aguilar
- Evelyn N Aguilar
- Veronica Elisa Aguilar
- Abdul Akthar Ahamath
- Sofia Ahmed
- Heayoun Ahn
- Christine Nnenna Akparanta
- Mohamed Fekry Al-Sadek
- Michelle Alabran
All providers in Tustin, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.